tbuckley/cabot-search huggingface dataset:
Abstract 10619: Pericoronary Fat Attenuation Index on Coronary Computed Tomography Angiography Predicts Hospitalization for Heart Failure in Patients With Suspected Coronary Artery Disease
Authors: Mitsutaka Nakashima, Toru Miyoshi, Takahiro Nishihara, Keishi Ichikawa, Takashi Miki, Yoichi Takaya, Rie Nakayama, Norihisa Toh, HIRONOBU TODA, Masatoki Yoshida, Kazuhiro Osawa, Hiroshi Ito
Journal: Circulation (2022)

Introduction: Chronic inflammation is focused as a cause of heart failure (HF). Pericoronary fat attenuation index (FAI) assessed on coronary CT angiography (CCTA), a maker of vascular inflammation, is reported to associate with risk of cardiac mortality. However, relationship between pericoronary FAI and development of HF has not been fully elucidated. Hypothesis: Pericoronary FAI predicts hospitalization for HF. Methods: A total of 1196 consecutive patients who underwent clinically indicated CCTA and transthoracic echocardiography for suspected CAD were enrolled. Patients with a history of CAD, hospitalization for HF, left ventricular ejection fraction (LVEF) &lt;40%, and hemodialysis were excluded. We assessed pericoronary FAI of proximal 40 mm segments for three major coronary arteries. Association between pericoronary FAI and incidence of hospitalization for HF was analyzed by Cox regression analysis. Results: During a median follow-up of 4.3 years, 29 hospitalizations for HF occurred. Pericoronary FAI of three major coronary arteries were significantly corelated each other. Pericoronary FAI of left anterior descending artery (LAD) was higher in patients with hospitalization for HF than in patients without hospitalization for HF (-61.4 ± 7.8 HU and -67.4 ± 7.2 HU, p&lt;0.001). Optimal cut-off value of pericoronary FAI of LAD for predicting hospitalization for HF was -64.8 HU. Pericoronary FAI of LAD (&gt;-64.8 HU) was significantly associated with hospitalization for HF after adjusted by age and gender (HR 4.77, 95%CI 2.10-10.81). In addition, these analyses were performed in 885 patients without significant stenosis (16 hospitalizations for HF occurred). In this cohort, pericoronary FAI of LAD in patients with hospitalization for HF was higher than that in patients without hospitalization for HF (-60.8 ± 7.2 HU and -67.3 ± 7.2 HU, p&lt;0.001), and association of FAI of LAD with hospitalization for HF remained significant. Pericoronary FAI of LAD was significantly correlated with left atrial volume index, left ventricular mass index, LVEF and E/e’, respectively (p&lt;0.001). Conclusions: Pericoronary FAI of LAD on CCTA may be a useful clinical predictor of hospitalization for HF in patients suspected CAD without history of CAD and hospitalization for HF.
Abstract 10178: Concurrent Left Ventricular and Left Anterior Coronary Artery Thrombus; <i>Is Covid-19 an Innocent Bystander?</i>
Authors: Vincenzo Somma, Anthony Brennan, Francis J Ha, Adam Trytell, Khoa Phan, Kegan J Moneghetti
Journal: Circulation (2022)

Case presentation: A 36-year-old male was admitted to a local hospital with respiratory failure secondary to COVID-19 pneumonia. Initial management included oxygen, dexamethasone and baricitinib. On day 14 of illness the patient developed severe chest pain associated with widespread dynamic ST segment elevation and an elevated high sensitivity troponin I (17516 ng/L). He was transferred to a tertiary center for cardiac evaluation. Cardiovascular risk factors included treated hypertension and obesity (BMI 34). Physical exam revealed a blood pressure of 145/95 mmHg, regular heart rate at 90 bpm and coarse crepitations in bilateral lower lungs with a 3L oxygen requirement. Differentials included myopericarditis however, clinical suspicion for an acute coronary syndrome remained high. Urgent coronary angiogram revealed a large filling defect (figure 1A) at the mid-vessel of the LAD at the 1st diagonal bifurcation, likely a thrombus. Dual antiplatelet therapy, heparin and tirofiban infusion were commenced. Furthermore, echocardiography performed the same day revealed a reduced LVEF secondary to LAD territory hypokinesis and an associated apical left ventricular thrombus measuring 2.2x1.3 cm (figure 1B). Once established on anticoagulation the patient experienced no further chest pain and was discharged home on warfarin.The left ventricular thrombus was monitored for resolution in the community with serial transthoracic echocardiograms. Discussion: Raised highly sensitive troponin in the vicinity of severe COVID-19 infection is common, however, when associated with chest pain and or dynamic ECG changes myocarditis must be considered. The cytokine storm triggered by a SARS-CoV-2 infection can be thrombogenic, resulting from increased platelet activation and decreased fibrinolysis. This process may further complicate the evaluation and acute coronary syndrome does need consideration, even in those patients at a younger age with minimal risk factors.
Abstract 10445: Detection of Viability and Clinical Implications Using Pet/Mri in Patients With Acute Myocardial Infarction
Authors: SaeHyun Park, Byung-ju Son, Hong-ju Kim, Kang-Un Choi, Jong-Ho Nam, Chan Hee Lee, Jang-Won Son, Ung Kim, Jong-Seon Park, Dong Gu Shin
Journal: Circulation (2022)

Background: The purpose of this study is to evaluate the role of viability on PET-MRI to predict improvement of echocardiographic findings such as regional wall motion index and left ventricular ejection fraction after successful percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI). Method: A total of 154 patients with AMI who was performed cardiac PET/MRI within 7 days after PCI were enrolled were enrolled. We performed TTE twice before and after in We performed TTE twice before and after PCI in 103 patients. We categorized these patients according to presence of viability on PET-MRI: group A (N=53, patients with viability on PET-MRI) and group B (N=50, patients without viability on PET-MRI) and compared. The primary end point is improvement of regional wall motion abnormality (RWMA) on TTE. Results: Clinical and angiographic findings were similar between the two groups during follow-up of 11months. Among 53 patients in group A, 30 patients (56.6%) showed the result of slight improvement of RWMA on TTE and among them 13 patients (24.5%) showed result of disappeared RWMA on TTE. In contrast, among 50 patients in group B, 22 patients (44%) showed the result of slight improvement and among them, only 4 patients (8%) showed result of disappeared RWMA on TTE. The proportion of patients who showed slight improvement of RWMA between two groups are not statistically significant (p=0.201). But, the proportion of patients who showed disappeared RWMA between two groups are statistically significant (p=0.024). Conclusions: PET/MRI is useful tool to detect viability in patients with AMI. It seems to be predictable to improve cardiac function for the patients with viability on PET-MRI.
Abstract 10151: Detection of Cardiac Involvement in Eosinophilic Granulomatosis With Polyangiitis (EGPA) With Multiparametric Cardiovascular Magnetic Resonance (CMR)
Authors: Alina X Hua, Agata Sularz, Jaideep Dhariwal, Alexandra Nanzer, David Jackson, Tevfik F Ismail
Journal: Circulation (2022)

Background: EGPA is a rare small-vessel vasculitis. Cardiovascular (CV) involvement is an important predictor of adverse outcomes but is challenging to detect. CMR is as an excellent tool to detect cardiac EGPA but is not widely available. It is unknown who would benefit most from comprehensive CV assessment with CMR. We aimed to determine the prevalence of cardiac EGPA with multiparametric CMR and to identify potential clinical/biochemical predictors of CV involvement. Methods: This single-center study was performed in EGPA patients who underwent CMR as part of routine clinical evaluation including comprehensive tissue characterization with T1 mapping, T2-STIR, T2 mapping, and late gadolinium enhancement imaging, in accordance with SCMR guidelines. Results: Sixty-three EGPA patients were included (Table 1). CV involvement (defined by typical LGE, LV dysfunction or pericardial inflammation) was seen in 37%. The median LV and RV ejection fraction was 58% and 57%. Two (3%) patients demonstrated increased T2 signal and mapping values, suggesting acute cardiac injury. LGE was present in 18 (29%) patients with a predominant pattern of subendocardial fibrosis. Patients with CV involvement were younger when diagnosed with EGPA, had higher NT-pro-BNP level (sensitivity 30%, specificity 98%) and lower EF (sensitivity 48%, specificity 100%) (Table 1). Troponin levels were not predictive of CV involvement (Table 1) as defined by positive CMR. Conclusion: Clinical and biochemical markers had low sensitivity for detecting cardiac involvement which was present in over a third of patients. CMR is necessary to detect cardiac involvement and should be considered part of the baseline evaluation of patients with EGPA.
Abstract 04: Chest Compressions Superimposed With Sustained Inflations Compared to Continuous Chest Compressions with Asynchronized Ventilation During Cardiopulmonary Resuscitation in Asphyxiated Pediatric Piglets - A Randomized Controlled Animal Study
Authors: Chelsea Morin, Po-yin Cheung, Tze Fun Lee, Megan OReilly, Georg Schmolzer
Journal: Circulation (2022)

Introduction: Respiratory arrest is the leading cause of pediatric cardiac arrest. Pediatric CRP guidelines therefore focus on respiratory support during CPR, but the optimal approach to oxygen delivery and coronary perfusion during pediatric CPR is not known. Animal studies reported that chest compressions superimposed with constant high distending pressure, or sustained inflation (CC+SI), significantly reduces time to return of spontaneous circulation (ROSC) compared to 3:1 chest compression:ventilation in neonatal piglets or chest compressions with asynchronous ventilation (CCaV) in pediatric piglets. During CC+SI, both cardiovascular and respiratory parameters were improved, which resulted in the faster time to ROSC. Hypothesis: In the current study, we hypothesized that CC+SI, compared to CCaV, would reduce time to ROSC in pediatric piglets with asphyxia-induced cardiac arrest. Methods: Twenty-eight pediatric piglets (21-24 days old, 7.5-9.2 kg) were anesthetized, intubated, instrumented, and exposed to 30 min normocapnic hypoxia followed by asphyxia. Piglets were then randomized to, and received, either CC+SI or CCaV for resuscitation (n=14 per group). Resuscitative efforts were continued until ROSC was achieved, or up to a maximum of 10 min. Hemodynamic parameters were monitored throughout the experiment and up to 30 min post-ROSC. Results and Conclusions: Overall, the mean (SD) time to ROSC was 208 (190) sec with CC+SI and 388 (258) sec with CCaV (p=0.045) (Table 1). There was a 100% increase in the number of piglets achieving ROSC with CC+SI compared to CCaV (CC+SI n=12 versus CCaV n=6, p=0.046). Median minute ventilation in the CC+SI group was 2,315 mL/min compared with 354 mL/min in the CCaV group (p=0.0001). Both systolic and diastolic blood pressure were higher in the CC+SI group, compared to the CCaV group throughout resuscitation. In summary, CC+SI improved time to ROSC and increased the number of piglets achieving ROSC. There was significantly higher minute ventilation with CC+SI, compared to CCaV, and both systolic and diastolic blood pressure were higher throughout resuscitation with CC+SI compared to CCaV. Studies in pediatric patients using CC+SI are warranted.
Abstract 10567: Sepsis-Related Early Mortality After Transvenous Lead Removal
Authors: Min Choon Tan, Justin Z Lee, Abhishek Deshmukh, Dan Sorajja, Arturo M Valverde, Komandoor Srivathsan, Luis Scott, Fred Kusumoto, Paul Friedman, Samuel Asirvatham, Siva K Mulpuru, Yong-Mei Cha
Journal: Circulation (2022)

Background: Recognition of the infectious characteristics among the sepsis-related early mortality after transvenous lead removal (TLR) is an essential step to improving patient outcomes. Objective: This study sought to understand the infectious characteristic and circumstances among the sepsis-related early mortality after TLR. Methods: We performed a retrospective analysis of all patients undergoing TLR from January 1, 2001, to January 1, 2021 at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). Patient details were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system and outside records when available. Results: A total of 2,319 patients were included in the study. The overall 30-day sepsis-related mortality rate was 1.25% (n=29). Among the sepsis-related deaths, 24 patients (83%) had systemic cardiac implantable electronic device (CIED) infection, and 4 patients (14%) initially had isolated pocket infection. The average time from admission to TLR was 11 days. MSSA was the most common organism (n=8, 28%), and this was followed by MRSA (n=4, 14%) and Candida (n=3, 10%). Twenty of these patients (69%) had vegetation on the echocardiogram: vegetation on lead only in 9 patients, vegetation on both valve and lead in 8 patients, and vegetation on valve only in 3 patients. Among valvular vegetations, 5 patients had tricuspid valve vegetations, 3 patients had aortic valve vegetations, 2 patients had mitral valve vegetations, and 1 patient had both mitral and aortic valve vegetation. The average size of vegetation was 1.3±0.8 x 1.1±0.6 cm. Conclusions: The 30-day sepsis-related mortality rate was 1.25%. Among the sepsis-related early deaths, MSSA was the most common organism, and more than two-thirds (69%) of the patients had vegetations on cardiac imaging. This highlights the importance of further research to improve the infection outcome in TLR patients.
Abstract 10856: Artificial Intelligence-Guided Screening for Atrial Fibrillation Using the Electrocardiogram in Sinus Rhythm
Authors: Peter A Noseworthy, Zachi I Attia, Emma M Behnken, Rachel E Giblon, Katherine A Bews, Sijia Liu, Tara Gosse, Zachery D Linn, Yihong Deng, Jun Yin, Bernard J Gersh, Jonathan Graff-Radford, Alejandro A Rabinstein, Konstantinos Siontis, Paul Friedman, Xiaoxi Yao
Journal: Circulation (2022)

Introduction: Prior AF screening trials demonstrated low yield, highlighting the need for more targeted approaches. An AI algorithm was developed to identify ECG signatures of AF risk during normal sinus rhythm, which has been validated in diverse external populations. Hypothesis: An AI-guided, targeted screening approach could improve the diagnosis of AF. Methods We conducted a pragmatic decentralized trial to prospectively recruit patients with stroke risk factors but no prior AF. The AI algorithm was applied to the ECGs performed in routine practice and divided patients into high- or low-risk groups. The primary endpoint was AF lasting ≥ 30 seconds on a subsequent 30-day continuous cardiac rhythm monitor. In a secondary analysis, trial participants were 1:1 propensity score-matched to real-world controls derived from the eligible but unenrolled population. Results A total of 1,003 patients from 40 U.S. states completed the study, with a mean age of 74 [SD 8.8] years. Over a mean of 22.3 days of continuous monitoring, AF was detected in 6 (1.6%) of low-risk patients and 48 (7.6%) of high-risk patients (OR 4.98 [2.11-11.75], p&lt;0.001). Compared to usual care, AI-guided AF screening was associated with increased detection of AF (high-risk group: 4.2% vs. 11.1%, p&lt;0.001; low-risk group: 0.9% vs. 2.4%, p=0.12) over a median follow-up of 10 months. Conclusions A prospective pragmatic study found that the AI a can risk-stratify a relatively uniform population (i.e., older adults at risk for stroke) to detect AF during short-term cardiac monitoring. Furthermore, when compared with usual care, AI-guided cardiac monitoring was associated with increased AF detection. As such, an AI-guided AF screening approach, leveraging existing EHR data and infrastructure, could be effective, patient-centered, and massively scalable, thereby reducing unnecessary health utilization and diagnosis-related anxiety (Clinicaltrials.gov: NCT04208971).
Abstract 10387: Macrophage Migration Inhibitory Factor Maintains Mitochondrial Integrity in Aging During Ischemic Insults
Authors: Hao Wang, Linda Ines Zoungrana, Zehui Li, Migdalia Iglesias, Kayla Davitt, Mohammad Fatmi, Meredith Krause-Hauch, Ji Li
Journal: Circulation (2022)

Introduction: The expression and secretion of cardiac MIF (macrophage migration inhibitory factor) are downregulated in aging. A small molecule MIF agonist, MIF20 can increase the binding affinity of MIF with CD74 receptor to modulate AMPK signaling. However, the pharmacological mechanisms by which MIF20 triggers MIF-AMPK signaling cascade to benefit heart in response to ischemia and reperfusion (I/R) stress remain unknown. Hypothesis: MIF20 rescues an impaired MIF-AMPK signaling in aging through augmenting the interaction between MIF and CD74 receptor to maintain mitochondrial integrity of aged heart under ischemic stress. Methods: Young (3-5 months) and aged (21-24 months) C57BL/6J mice were subjected to 45 min of ligation of LAD (left anterior descending coronary artery) and injection of MIF20 (0.15 μg/kg, i.v.) 5 min before 24 hr of reperfusion with release of LAD. Echocardiography measures cardiac functions, and TTC/Evans blue staining for determination of myocardial infarction size. Seahorse XF Analyzer for mitochondrial respiration functions of isolated cardiomyocytes. Results: The echocardiography data showed that I/R caused cardiac systolic dysfunctions but not effect on cardiac diastolic functions of both young and aged C57BL/6J mice. There were no differences between male and female groups. Administration of MIF20 significantly ameliorated I/R-induced cardiac dysfunctions in both young and aged mice, while more improvement observed in aged versus young mice. MIF20 treatment reduced myocardial infarct size caused by I/R in both young and aged mice, but the reduction extent of aged hearts was higher than that of young hearts (p&lt;0.05). Mitochondrial respiration rates of isolated cardiomyocytes as indicted by ATP production were impaired by I/R versus sham operations in both young and aged hearts. Intriguingly, MIF20 treatment significantly rescued the impaired mitochondrial functions caused by I/R in both young and aged cardiomyocytes. Moreover, the mitochondrial functions of young and aged cardiomyocytes were improved to a similar level under I/R with MIF20. Conclusions: MIF agonist MIF20 rescues the impaired energy metabolism in aged heart. The mitochondrial integrity under I/R by MIF20 could limit ischemic insults in aging.
Abstract 10573: Left Ventricular Structure, Function, and Clinical Outcomes in Methamphetamine-Associated Heart Failure
Authors: Emily R Cedarbaum, Matthew S Durstenfeld, Sithu Win, Brian Haas, Jonathan D Davis, Alan H Wu, Danny Li, Shreya Swaminathan, Victor Arechiga, Teresa Wang, Priscilla Y Hsue
Journal: Circulation (2022)

Introduction: Methamphetamine use and overdose deaths are increasing. People who use methamphetamine are at risk for methamphetamine-associated heart failure (meth-HF). Cardiac fibrosis has been reported in nonischemic cardiomyopathies, but the role of cardiac fibrosis and other factors underlying the pathophysiology and reversibility of meth-HF remain unknown. Methods: Participants with meth-HF were recruited into a prospective cohort at a safety net hospital in San Francisco. Data collection included medical history, clinical outcomes, longitudinal echocardiograms (TTEs), markers of inflammation and fibrosis, and cardiac magnetic resonance imaging (CMR). Outcomes included mortality, changes in LVEF, and hospital readmission. Results: Forty-six participants enrolled: median age 51 years, 83% male, 41% Black, 20% Asian, 33% unstably housed, 76% actively using methamphetamine. Baseline TTEs demonstrated LV dilation (median LVIDd 5.7cm, LVIDs 4.7cm) and severely reduced LV systolic function (LVEF&lt;30% in 62%). After median 9 months follow-up, 13% were deceased. Compared to survivors, baseline LV dimensions were larger (mean LVIDd 6.7 vs 5.5cm, p&lt;0.05; LVIDs 6.1 vs 4.5cm, p&lt;0.05) and LVEF was lower (mean 19% vs 29%, p&lt;0.05) among those who died. At baseline, smaller LV size, higher LVEF, and guideline-directed medical therapy (GDMT) were more common in those with LVEF improvement &gt;10% (Fig). CMRs were often abnormal with late gadolinium enhancement and elevated extracellular volume, but there was no clear association with LV recovery. Conclusions: Despite their young age, the meth-HF population has a high mortality rate and severely reduced LVEF with LV dilation. Smaller LV size, higher LVEF, and GDMT were more common in those with LVEF improvement. These findings suggest that early identification and treatment of heart failure in people who use methamphetamine, along with drug cessation, may be associated with reversibility and improved outcomes.
Abstract 10342: Sarm1 Deficiency Ameliorates Diabetic Cardiomyopathy by Reversing Lipid Metabolism and Fibrosis
Authors: Chi Fung Lee
Journal: Circulation (2022)

Introduction and hypothesis: Diabetes is a risk factor for heart disease and decline in NAD levels is associated with cardiometabolic disease. We aimed to test a hypothesis and identify mechanisms by which deletion of SARM1 NAD hydrolase ameliorates diabetic cardiomyopathy. Methods and Results: Metabolomic analysis found that 67 out of 243 plasma metabolites showed changes in unstressed SARM1-KO mice (KO), including elevated levels in markers of metabolic disorder, e.g. phosphatidylcholine or ceramide. Baseline blood glucose levels was slightly elevated in KO. RNA-seq analyses of WT and KO hearts did not find changes in genes of lipid metabolism, suggesting confounding impacts of SARM1 deficiency in other tissues on the altered plasma metabolism. Despite the changes in metabolite levels, KO had no change in cardiac structure and function. WT and KO were challenged with 16-week type 1 diabetic stress. Diabetic WT showed progressive systolic (FS: 50% vs 34%; P&lt;0.01) and diastolic dysfunction (E’/A’: 1.5 vs 1.0, P&lt;0.01), both of which were attenuated by SARM1 deficiency (FS to 48%; E’/A’ to 1.4, P&lt;0.01). Despite differences in baseline metabolite levels, fasting glucose levels were similarly elevated in diabetic WT and KO. Metabolomic analysis showed little changes in diabetic KO plasma, suggesting that the cardioprotection in KO is due to the reversal of cardiac pathogenic mechanisms. SARM1 deficiency normalized the decline in cardiac NAD levels of diabetic hearts, with similar expressions of other NAD hydrolases, Bst1 and Cd38. Diabetic WT hearts up-regulated cardiomyopathy markers such as nppb, Nox4 mRNAs, and myh7/myh6 ratio, which were normalized by SARM1 deficiency. Chronic diabetes promoted cardiac fibrosis and induced profibrotic gene expressions, which were suppressed by SARM1 deficiency. RNA-seq analysis showed that chronic metabolic stress induced gene expressions of lipid metabolism in diabetic WT hearts. SARM1 deficiency reversed some of these upregulation, suggesting that cardiac SARM1 may regulate lipid metabolism in diabetic hearts via maintaining NAD homeostasis. Conclusion: Our data suggest that SARM1 regulates metabolism and fibrosis in the progression of diabetic cardiomyopathy but underlying mechanisms are to be dissected.